Understanding the rise of health GPPPs : the role of discourse and ideas

Abstract

This thesis attempts to answer the following question: How was it possible for Global Public-Private partnerships (GPPPs) to rise to prominence as a key mechanism of global health governance (GHG)?  I argue that in order to understand this development, it is important to take into account the role of discourse and ideas.  Most studies of GHG, which I categorise as either power-based or interest-based, do not take discourse and ideas seriously.  I propose an alternative, constructivist approach to GHG that does take them seriously.  I do not argue that constructivism provides a better account of GHG than either power-based or interest-based analyses, but I do argue that it provides additional and important insights into the dynamics of GHG.

From the initial claim that discourse and ideas are important to understand the rise of GPPPs, I show in my thesis how, where, and when they are important.  In response to the question of how ideas and discourse are important, I argue that they constituted and constructed the practice of GPPP.  To show this, I develop a discursive framework that examines four functions of discourse: the cognitive, the normative, the coordinative, and the communicative.  I apply this framework to three neglected disease GPPPs: the Stop TB partnership, the Drugs for Neglected Disease Initiative, and the Global Alliance for TB Drug Development.   I show that even though these GPPPs had quite different institutional structures, they were discursively constructed in the same way.

In response to the question of where ideas and discourse are important, I distinguish between micro and macro levels. At the micro level, I show that the four functions of discourse did not operate equally across each of the three GPPPs.  At the macro level, I show that the key architects of the three GPPPs comprised a network of global health actors.  I argue that the relationship between the actors that comprised the network, and the ideas that structured it, can be conceived in structurationalist terms.

In response to the question of when ideas and discourse are important, I argue that ideas and discourse ‘truly matter’ when they reconfigure actors’ interests, and to more than simply reflect institutional path dependence and cultural norms.  The evidence for this in my study of the rise of GPPPs is, however, scant.  I show that the ideas and discourse of GPPP actually took place against four ‘background conditions’ that themselves were crucial for the change from public and private global health provision to global public-private partnership.  When these conditions pertained, it was possible for the discourse and ideas of GPPP to flourish.

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